Preventive Services For Adults

Transcription

1 Preventive Services For Adults Listed within this guide is a summary of preventive care services available to you and your dependents under the University Health Care Plans. The University Health Care Plans cover these services at 00% if you visit an in-network provider. The services outlined in this guide follow the National Guidelines for Preventive Care Services, as established by the U.S. Preventive Care Services Task Force, an independent panel of experts in primary care and prevention that reviews the evidence of effectiveness and develops recommendations for clinical preventive services.

2 Procedure Age 9-9 Age 0-9 Age 50-6 Age 65+ High/ Increased Risk Population Preventive Visit & a Counseling Every -5 years for women, every 5 years for men Every - years High Blood Pressure Screening Every years if below 0/85, more frequent intervals for higher levels Colonoscopy If at high risk,, Colonoscopy every 0 years or Fecal Occult Blood Test yearly and/or Flexible, Sigmoidoscopy every 5 years If African American, begin screening at age 5 Personal history of colorectal cancer or, adenomatous polyps Personal history of inflammatory bowel disease b First degree relative with colorectal cancer, before the age of 60 b First order relative diagnosed with colon cancer before age 65 or first order relatives diagnosed at any age Family history of hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary non-polyposis colon,, cancer) Personal history of ulcerative colitis Syphilis Infection Screening If at increased risk; clinical judgment used as to frequency Pregnant women test at st prenatal visit. Repeat testing in rd trimester and at delivery for high risk groups,, Commercial sex workers Presence of other STDs Men who have sex with men and engage in high risk sexual behavior Persons who exchange sex for drugs Persons incarcerated Sexual contact with active syphilis Women Total Cholesterol/HDL If at increased risk for coronary heart disease, Begin at age 5. Every 5 years, shorter intervals if lipid levels close to warranting therapy, longer intervals if lipid levels are low or repeatedly normal Diabetes Family history of cardiovascular disease before age 50 in male relative or age 60 in female relative Family history of hyperlipidemia Multiple coronary heart disease risk factors (e.g., tobacco use, hypertension)

3 Procedure Age 9-9 Age 0-9 Age 50-6 Age 65+ High Risk Population Mammography Pap Smear Chlamydia Screening Gonorrhea Screening If at increased risk Every - years, with or without clinical breast exam (CBE) Begin screening years after onset of sexual activity or age, whichever comes first. Screen annually until consecutive normal pap smears, then, every years Women with certain risk factors should continue to be screened annually. Screen all sexually active women 5 and, under c,, If at high risk; screening interval uncertain, take into account results from previous screening If at increased risk for infection; optimal frequency unclear Also screen all asymptomatic pregnant women 5 and under Screen all sexually active women, including those pregnant, if at increased risk Can be discontinued if normal results for,, 0 years Family history Genetic tendency, Past breast cancer Previous breast biopsy showing atypical hyperplasia Diethylstilbestrol (DES) exposure before birth HIV infection Weakened immune system due to organ transplant, chemotherapy or chronic steroid use Unmarried, New or multiple sexual partners, Repeated episodes of STD s Commercial sex work African-American race Cervical ectopy Inconsistent use of barrier contraceptives Under age 5 History of previous infection Other sexually transmitted infection New or multiple sex partners Inconsistent condom use Sex work Drug use, Hepatitis B Screening Pregnant women screen at st prenatal visit Rh (D) Incompatibility Pregnant women - screen at st prenatal visit Asymptomatic Bacteriuria Screening Pregnant women screen at -6 weeks gestation Osteoporosis If at increased risk, begin screening at age 60 Every years Low body weight (weight <70 kg) No current use of estrogen therapy

4 Procedure Age 9-9 Age 0-9 Age 50-6 Age 65+ High Risk Population Men Total Cholesterol/HDL If at increased risk for coronary heart disease Begin at age 5. Every 5 years, shorter intervals if lipid levels close to warranting therapy, longer intervals if lipid levels are low or repeatedly normal Diabetes Family history of cardiovascular disease before age 50 in male relative or age 60 in female relative Family history of hyperlipidemia Multiple coronary heart disease risk factors (e.g., tobacco use, hypertension) Prostate Cancer Screening If at increased risk PSA blood test and digital rectal exam offered annually to men who have at least a 0 year life expectancy African-American men Family history of st degree relative diagnosed at early age Abdominal Aortic Aneurysm Screening Age 65-7, if at risk, should receive one time ultrasound, screening Have ever smoked > 00 cigarettes in, lifetime Td Tetanus, Diphtheria Booster every 0 years, Influenza (flu) Annual for adults at risk Annual,, Chronic illness (asthma, diabetes, cardiac disease, renal dysfunction, HIV) Any condition that compromises respiratory function (e.g., cognitive dysfunction, spinal cord injury, seizure disorder or other neuromuscular disorder) Health care workers Residents of nursing homes and long-term care and assisted living facilities Pregnant women Pneumococcal vaccine (PPV) Once for adults with risk factors. Booster after 5 years for adults at, highest risk and those most likely to lose their immunity. Once at age 65; booster after 5 years if < 65 at time of primary vaccination, Chronic illness Immunosuppressive conditions HIV infection Residents of nursing homes and other long-term care facilities Alaska Natives and certain American Indian populations

5 Procedure Age 9-9 Age 0-9 Age 50-6 Age 65+ High Risk Population Varicella (Chicken pox) Note: Women who are pregnant (or planning to become pregnant in the next four weeks) should NOT be vaccinated. Persons < 50 with no history of varicella, test for immunity. Immunize if negative. If >50, assume immunity for adults who might be at risk for exposure or transmission and have no history of varicella infection and blood test does not confirm immunity, administer doses -8 weeks apart Health care workers or family of immunocompromised persons Persons who live or work in environment where transmission is likely (teachers, child care, institutional settings, college students, military personnel) Persons incarcerated International travelers Women who are not pregnant but who might become pregnant MMR (Measles, Mumps, Rubella) Note: Women who are pregnant (or planning to become pregnant in the next four weeks) and people, whose immune system is not working properly, should NOT be vaccinated. Hepatitis A Born before 957, can be considered immune Born in 957 or later, at least one dose of MMR unless history of prior vaccination or evidence of immunity. Second dose recommended if at risk Only those at risk Those at risk, doses at least 6 months apart In an age group affected during a mumps outbreak Student in post secondary educational institutions Work in health care facility International traveler Users of illegal drugs Travel to countries with high prevalence of Hepatitis A Chronic liver disease or clotting factor disorders Work involving exposure to Hepatitis A virus infected people Men who have sex with men

6 Procedure Age 9-9 Age 0-9 Age 50-6 Age 65+ High Risk Population Hepatitis B Meningococcal Meningitis Only those at risk. If at risk, doses (nd dose at least month after st dose; and rd dose at least months after nd dose and months after st dose) Only those at risk. If at increased risk, dose (additional dose may be recommended for those who, remain at high risk) Injection drug user Hemodialysis patients or history of receiving clotting factors Work involving possible exposure to blood (healthcare professionals) Clients and staff of institutions for developmentally disabled More than one sexual partner during previous 6 months Hepatitis B infected sexual partner or household contact History of STD s Men who have sex with men Persons incarcerated Travel to countries with high prevalence of Hepatitis B Persons with HIV infection Chronic liver disease No spleen or spleen problems Immune system not working properly U.S. military recruits Travelers to developing countries First year college students living in dormitories Microbiologists routinely exposed to isolates of Neisseria meningitidis Tuberculin Skin Test Annual testing for high-risk group (method: 5 tuberculin units of PPD) Symptoms or radiographs suggesting TB Contact with person with confirmed or suspected TB Immigrating from endemic areas Immunosuppressive conditions HIV positive or living with HIV positive person Persons incarcerated Health care workers

7 Procedure Age 9-9 Age 0-9 Age 50-6 Age 65+ High Risk Population Human Papillomavirus (HPV) At discretion of treating physician, approved for all women 9-6 years, if not previously vaccinated. Three dose series dose # two months after dose #, and dose # four months after dose # a b c Counseling topics include aspirin prophylaxis, tobacco cessation, alcohol/drug use, depression/anxiety awareness, diet (limit fat and cholesterol, maintain caloric balance, emphasize grains, fruit, vegetables, physical activity) folic acid supplements, risk factors and prevention for osteoporosis, injury prevention (lap/shoulder belts, appropriate helmet use, smoke detector use, safe storage/removal of firearms, violence prevention), sexual behavior (STD prevention, unintended pregnancy), dental and periodontal disease, skin cancer counseling. First order or first degree relative includes siblings, parents and children. Family history of breast cancer in mother, daughter or sister, previous breast biopsy revealing atypical hyperplasia or first childbirth after age 0. Source: U.S. Preventive Services Task Force (USPSTF), The Guide to Clinical Preventive Services Institute for Clinical Systems Improvement (ICSI), Preventive Services for Adults, Twelfth Edition/October services_for_adults_.html American Cancer Society (ACS), Cancer Facts & Figures x_acs_cancer_detection_guidelines_6.asp Department of Health and Human Services, Center for Disease Control and Prevention (CDC), Recommended Adult Immunization Schedule, October 006 September 007. Approved by the Advisory Committee on Immunization Practices (ACIP), the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Family Physicians (AAFP) Disclaimer: These guidelines incorporate and summarize recommendations for adult preventative services from select publicly available primary sources. This document includes frequently considered preventative procedures but does not include all procedures for which guidelines exist or all primary sources. These guidelines do not necessarily represent the view of the University of Rochester or its consultant, Mercer Human Resource Consulting. While Mercer has endeavored to ensure all the information contained herein is accurate and current at the time of publication, Mercer does not endorse or guarantee the accuracy of the information. Mercer disclaims all warranties, express or implied, with respect to these guidelines and shall have no liability to any party relating to the accuracy or completeness of these guidelines or for any damages arising out of the use or non-use by any party of any information contained herein. Each user is encouraged to consult other available sources to confirm that the information in these guidelines reflects the most current information available from the sources cited herein.

8 Preventive Services for Children and Adolescents Listed within this guide is a summary of the preventive care services available to your covered eligible dependents under the University Health Care Plans. The University Health Care Plans cover these services at 00% if you visit an in-network provider. The services outlined in this guide follow the National Guidelines for Preventive Care Services, as established by the U.S. Preventive Care Services Task Force, an independent panel of experts in primary care and prevention that reviews the evidence of effectiveness and develops recommendations for clinical preventive services.

9 Immunization Birth Month High Risk Population Hepatitis B Routine Vaccination Series (Mother known to be HBsAg negative): Birth Dose - Newborns receive monovalent HepB after birth and before hospital discharge nd Dose - Either monovalent HepB or combination vaccine with HepB at age - months rd Dose - Either monovalent HepB or combination vaccine with HepB at age weeks th Dose - If only combination vaccines have been given after the birth dose, a fourth dose may be given) Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg after completion of the HepB series, at age 9-8 months (generally at the next well-child visit after completion of the vaccine series) Children not Previously Immunized (Full Routine Series): Should receive three doses of HepB vaccine -- The st and nd doses given at least weeks apart; the rd doses at least 8 weeks after the nd and 6 weeks after the st. The last dose of HepB vaccine should not be given before 6 months of age Diphtheria, Tetanus, Pertussis (DTaP & Tdap adolescent preparation) Administer first dose of DTaP at months, second at months and third at 6 months, Fourth dose of DTaP may be administered as early as months, provided 6 months have elapsed since the third dose and child is not likely to return at age 5-8 months Final dose in series given at age > years,, Single dose of Tdap at age - years, for those who completed recommended childhood DTaP series and have not received a tetanus and diphtheria (Td) booster. Adolescents -8, who missed the - year booster, should also receive a, single Tdap dose. Haemophilus influenzae type b (Hib) Hib vaccine administered at, & 6 months (if Hib vaccine type PRP-OMP is used at and months, then the third, dose at 6 months not required) Final Hib dose in series administered at, months Inactivated Poliovirus (IPV) Administer first dose of IPV at months, second at months and third at 6-8 months, Fourth and final IPV dose, Measles, Mumps, Rubella (MMR) First MMR dose any time on or after first birthday, but optimally by 5 months of age, Second MMR dose at -6 yrs, If second MMR dose has not yet occurred, it can be given at, - yrs

10 Immunization Birth Month High Risk Population Varicella At or after age months for susceptible children, Susceptible children, not previously vaccinated receive two doses at least weeks, apart Susceptible defined as lacking reliable history of previous, chickenpox infection Hepatitis A (HepA) All children at year of age. The doses in the series should be given at least 6, months apart If this series is missed between - yrs, high risk children may complete series, anytime between -8 yrs. Persons who travel to developing, countries, Clotting factor disorders, Chronic liver disease Children attending day care centers Institutions for persons with developmental disabilities Meningococcal If at high risk, all children age > years should be vaccinated. Children age -0 should receive MPSV vaccine type and older children should receive MCV, vaccine type For high risk children not yet vaccinated, MCV should be given to all children - years old, or to adolescents entering high school at 5, years Other adolescents who wish to decrease their risk may also be vaccinated preferably with MCV, but MPSV is an acceptable alternative Terminal complement, deficiencies Anatomic or functional asplenia Persons who travel to or reside in countries in which N. meningitidis is epidemic, particularly if contact with the local population will be prolonged, Pneumococcal (PCV) Three doses of PCV7 given at,, and 6 months. A fourth (booster) dose recommended at -5 months of age, If at high risk, children -5 years: Previously vaccinated with PPV, should receive doses of PCV7, separated by at least 8 weeks Previously received PCV7, should receive dose of PPV no sooner than months after last dose of PCV7 If at high risk, children -8 years: Should receive booster with PPV five or, more years after last PCV7 Functional or anatomic asplenia, especially sickle cell disease,, HIV infection Racial and ethnic groups: Alaska Native, African American, American Indian Child care center attendance, Cochlear implant, Hematologic malignancy, Chronic renal failure Nephrotic syndrome, Chronic corticosteroid or, immunosuppressive therapy, Asthma

11 Immunization Birth Month High Risk Population Influenza Rotavirus Oral use, of RotaTeq, at, and 6 months of age. First dose given between 6- weeks and two additional doses give at -0 week intervals. Do not start the series later than age weeks. The series should be completed at weeks of age Vaccinate annually for healthy children aged 6-59 months If at high risk: Vaccinate on an annual basis for children > 59 month,,, Asthma, Cardiac disease Sickle cell disease HIV Diabetes Conditions that compromise, respiratory function Persons (including household members) in close contact with, persons in groups at high risk Persons 6 months 8 years old who are receiving long-term aspirin therapy Caution is advised when administered to immunocompromised infants Human Papilloma Virus (HPV) Routine Series: All females age, -. Three doses dose # two months after dose #; dose # four months after dose # At discretion of treating physician, approved for females age -8 if not previously vaccinated, At discretion of treating physician, approved for use with females 9-0, years

12 Immunization Procedure Birth Month High Risk Population Preventive Visit & Counseling a Preventive service visits recommended within the first two weeks after birth and at,, 6-9, and 5 months of age Preventive visit at age, primarily for counseling Recommended: Age -6, one or two preventive service visits Age 7-9, one or two preventive service visits Age, preventive service visit Age -8, one or two counseling visits Total Cholesterol and HDL-Cholesterol Non-fasting serum total cholesterol for children at risk. Once a child or adolescent has been screened any time between the ages of to 0, they do not need to have the screening repeated Parent or grandparent with a history of cardiovascular disease (CVD), peripheral vascular disease or cerebrovascular disease prior to age 55. Parent with history of total cholesterol >0 mg/dl Screening for Visual Impairment in Children <5 Screen to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years Prevention of Dental Caries in Preschool Children Prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months of age whose primary water source is deficient in fluoride Tuberculin Skin Test (TB) If at high risk Close contact to individuals with known or suspected TB Persons with HIV Persons at increased risk for disease if infection occurs (e.g., immunosuppression) Persons immigrating from endemic areas (Asia, Middle East, Africa and Latin America) Medically underserved, low income populations High-risk racial or ethnic minority populations Infants, children and adolescents exposed to adults in high risk categories

13 Immunization Procedure Birth Month High Risk Population Blood Lead Screening If at risk, a capillary blood lead test should be done around - years of age, and up to six years of age if not previously screened Child is receiving governmental assistance such as WIC or medical assistance During the past six months has lived in or regularly visited a home, childcare or other building built before 950 During the past six months has lived in or regularly visited a home, childcare or other building built before 978 with recent or ongoing repair, remodeling or damage (such as water damage or chipped paint) Child or his/her sibling, playmate or housemate had an elevated blood lead level a Counseling topics include injury prevention (helmet use, car seat, booster seat and seat belt use, smoke detector use, fire prevention in home, firearms, choking, falls, poisoning, water safety, violence and abuse ), developmental/behavioral assessment, infant sleep positioning and SIDS, Viral Upper Respiratory Infection prevention (good hand washing technique), blood lead testing, physical activity and weight management, nutritional counseling, alcohol and tobacco use, sexual behavior (pregnancy and STD prevention), skin cancer counseling. Source: Department of Health and Human Services, Center for Disease Control and Prevention (CDC), Recommended Childhood and Adolescent Immunization Schedule, 007. Approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) www. cdc.gov/nip/recs/child-schedule.htm Institute for Clinical Systems Improvement (ICSI), Immunizations, Eleventh Edition/September Institute for Clinical Systems Improvement (ICSI), Preventive Services for Children and Adolescents, Twelfth Edition/October _children_guideline_/preventive_services_for_children_and_adolescents_5.html U.S. Preventive Services Task Force (USPSTF), The Guide to Clinical Preventive Services Disclaimer: These guidelines incorporate and summarize recommendations for childhood and adolescent preventative services from select publicly available primary sources. This document includes frequently considered preventative procedures but does not include all procedures for which guidelines exist or all primary sources. These guidelines do not necessarily represent the view of the University of Rochester or its consultant Mercer Human Resource Consulting. While Mercer has endeavored to ensure all the information contained herein is accurate and current at the time of publication, Mercer does not endorse or guarantee the accuracy of the information. Mercer disclaims all warranties, express or implied, with respect to these guidelines and shall have no liability to any party relating to the accuracy or completeness of these guidelines or for any damages arising out of the use or non-use by any party of any information contained herein. Each user is encouraged to consult other available sources to confirm that the information in these guidelines reflects the most current information available from the sources cited herein.